title: Difficulty diagnosing chronic cryptococcal meningitis in idiopathic CD4+ lymphocytopenia.
abstract: A 64-year-old man with idiopathic CD4(+) lymphocytopenia developed cognitive impairment and gait ataxia with isolated obstructive hydrocephalus, which was fatal. Cerebrospinal fluid showed mild pleocytosis, but the etiology was not revealed by extensive analysis. At autopsy, inflammatory cells, CD8(+) lymphocytes and abundant macrophages but not CD4(+) lymphocytes were infiltrating the meninges at the base of the brain. Electron microscopy demonstrated that inflammation was caused by Cryptococcus neoformans, which was localized exclusively within macrophages, where it grew with budding. Our study suggests that, in idiopathic CD4(+) lymphocytopenia, macrophages can efficiently phagocytize but inefficiently digest C. neoformans, thus representing a vehicle of chronic intracellular infection.
authors.affiliation: Dipartimento di Neuroscienze, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. sancesario@med.uniroma2.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sancesario
authors.forename: Giampiero
authors.initials: G
authors.lastname: Palmieri
authors.forename: Gemma
authors.initials: G
authors.lastname: Viola
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perfetti
authors.forename: Lucia
authors.initials: L
authors.lastname: Anemona
authors.forename: Roberto
authors.initials: R
authors.lastname: Floris
authors.forename: Simone
authors.initials: S
authors.lastname: Marziali
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bernardi
authors.forename: Luigi Giusto
authors.initials: LG
authors.lastname: Spagnoli
mesh_terms: D002908:Chronic Disease; D003455:Cryptococcus neoformans / Q000472:pathogenicity; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D008875:Middle Aged; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology